Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Electrocardiography, the First Affiliated Hospital of Soochow University, Suzhou, China.
Ann Noninvasive Electrocardiol. 2020 Jul;25(4):e12748. doi: 10.1111/anec.12748. Epub 2020 Feb 27.
Heart rate acceleration and deceleration capacities are novel parameters that can quantify sympathetic and vagal modulation. However, how acceleration and deceleration capacities associated with circadian blood pressure (BP) variation remains unknown.
A total of 141 patients with essential hypertension were included in our study. Based on the nocturnal decline rate of systolic BP (SBP), patients were divided into two groups, as dippers and nondippers. Baseline demographic characteristics, ambulatory blood pressure monitoring (ABPM) parameters, Holter recordings, and echocardiographic parameters were collected.
The absolute values of acceleration capacity (AC) (-7.75 [-8.45 ~ -6.3] ms vs. -6.6 [-8.25 ~ -5.2] ms, p = .047) and deceleration capacity (DC) (7.35 [6.1 ~ 8.1] ms vs. 6.3 [5.1 ~ 7.6] ms, p = .042) were significantly higher in dippers than in nondippers. By multivariate logistic regression analysis, left atrial diameter (LAd) was found to be an independent risk factor for nondipper status in acceleration capacity model (odds ratio 1.174, 95% confidence interval 1.019-1.354, p = .027) and deceleration model (odds ratio 1.146, 95% confidence interval 1.003-1.309, p = .045). Sleep SBP was positively correlated to acceleration capacity (r = .256, p = .002) and negatively correlated to deceleration capacity (r = -.194, p = .021).
The absolute values of acceleration capacity and deceleration capacity were higher in patients with dipper hypertension than in patients with nondipper hypertension. However, acceleration and deceleration capacities were not independent risk factors for blunted BP variation. Sleep SBP seemed to be better correlated to the impairment of autonomic nervous system (ANS) function than other ABPM parameters.
心率加速和减速能力是量化交感神经和迷走神经调节的新参数。然而，加速和减速能力与昼夜血压（BP）变化的关联尚不清楚。
本研究共纳入 141 例原发性高血压患者。根据收缩压（SBP）夜间下降率，将患者分为杓型和非杓型两组。收集基线人口统计学特征、动态血压监测（ABPM）参数、动态心电图记录和超声心动图参数。
与非杓型组相比，杓型组的加速度能力（AC）绝对值（-7.75[-8.45-6.3]ms 比-6.6[-8.25-5.2]ms，p=0.047）和减速能力（DC）绝对值（7.35[6.18.1]ms 比 6.3[5.17.6]ms，p=0.042）均显著更高。多元 logistic 回归分析发现，左心房直径（LAd）是 AC 模型（比值比 1.174，95%置信区间 1.019-1.354，p=0.027）和 DC 模型（比值比 1.146，95%置信区间 1.003-1.309，p=0.045）中杓型状态的独立危险因素。夜间睡眠 SBP 与 AC 呈正相关（r=0.256，p=0.002），与 DC 呈负相关（r=-0.194，p=0.021）。
与非杓型高血压患者相比，杓型高血压患者的 AC 和 DC 绝对值更高。然而，加速和减速能力不是血压变异性减弱的独立危险因素。夜间睡眠 SBP 与自主神经功能障碍的相关性似乎优于其他 ABPM 参数。
